Provider Demographics
NPI:1356300065
Name:BENNETT, HENRY LAWRENCE (LCPO FAAOP)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:LAWRENCE
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LCPO FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 E 5TH
Mailing Address - Street 2:THOMPSON CUSTOM ORTHOTIC AND PROSTHETIC
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1313
Mailing Address - Country:US
Mailing Address - Phone:509-624-1308
Mailing Address - Fax:509-624-5537
Practice Address - Street 1:502 E 5TH
Practice Address - Street 2:THOMPSON CUSTOM ORTHOTIC AND PROSTHETIC
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1313
Practice Address - Country:US
Practice Address - Phone:509-624-1308
Practice Address - Fax:509-624-5537
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI00000029222Z00000X
WAPS00000028224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP001757OtherAMERICAN BOARD FOR CERT O